Provider Demographics
NPI:1528774353
Name:ABOLARIN, IFEOMA LOVETH (PMHNP)
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:LOVETH
Last Name:ABOLARIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 W TOUHY AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2371
Mailing Address - Country:US
Mailing Address - Phone:773-440-0408
Mailing Address - Fax:773-265-3755
Practice Address - Street 1:1941 W TOUHY AVE APT 2A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2371
Practice Address - Country:US
Practice Address - Phone:773-440-0408
Practice Address - Fax:773-265-3755
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041348618363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health